Back to the ortho?

[severine]

Back to the ortho?-UPDATE post 17-UPDATED again post 65

Alrighty, tomorrow will be 3 weeks and I still have pain in my left knee. The orthopedist said it should be a couple of weeks before I was feeling up to skiing again, but if I was concerned, I could have it checked out again before our Sugarbush/MRG trip (which is now 2 weeks away). I guess this was because while he didn't think there was ACL damage, sometimes it can mask itself pretty well and ongoing pain (or increasing pain) can be a sign. When I saw the orthopedist, they did x-rays and he pushed my leg around in different manners to test pain, plus compared the injured knee to the non-injured knee. I've since learned that most rely on MRI for more accurate diagnosis (versus x-ray)....

What do you think?

Pain started out to the left of my kneecap (outside of my knee), but now I feel it there, under my kneecap when my knee is really bent, and behind my knee in the middle when standing really straight (almost hyper-extending the knee). Not crippling pain, just a constant reminder that there's something wrong, with the occasional "ouch" thrown in for good measure.

Experts want to chime in?

UPDATED in post 17

UPDATED in post 65

 

[Paul]

A good ortho can tell just by moving the knee around. My acl was diagnosed this way and the tibial plateau and the top of the fibula were both fractured, so there was mucho swelling.

Honestly, I could never feel much pain from the acl tear ,but then again, it was masked by the pain of broken bones. Even after the bones healed, it was hard to discern. Of course, mine was a complete tear, I suppose a partial tear may react differently. The fact that you mention the left side of the left knee would suggest damage to the LCL. However, mentioning pain behind the kneecap could mean ACL or PCL.

Get it checked. An MRI will tell what, where, if any damage is. Most likely if there is ligament damage, it is nothing too severe.

Does your knee feel unstable, or is it just a bit of discomfort and pain?

 

[severine]

Not unstable, just pain. I figured the pain would be less by now, but it's persistant. I basically am just wondering if I'm over-reacting or if it's a valid concern, having never been through this before. I did injure that same knee back in December in a bad fall, but it was fine after 2 weeks. I guess I expected the same this time, especially since the orthopedist said the same.

ETA: Some have questioned why I wasn't put in a brace or stabilizer. Not sure myself. I asked if I needed to do anything special or needed to brace it and was simply told to ice it and take ibuprofen. That I would be the best judge of how much I could handle. :? Then again, I'm sure many of his patients aren't stuck toting around a 20+ lb kid all the time, too. Or lifting a 45lber into the car, out, onto the changing table, etc.

 

[Paul]

Not unstable, just pain. I figured the pain would be less by now, but it's persistant. I basically am just wondering if I'm over-reacting or if it's a valid concern, having never been through this before. I did injure that same knee back in December in a bad fall, but it was fine after 2 weeks. I guess I expected the same this time, especially since the orthopedist said the same.

Its hard to describe, but when I blew my ACL, after the bones healed and I could walk again, I just knew. It didn't move or feel right. If you have any doubts, getting it checked certainly won't hurt (well, I don't know about your insurance, it might)

 

[Paul]

ETA: Some have questioned why I wasn't put in a brace or stabilizer. Not sure myself. I asked if I needed to do anything special or needed to brace it and was simply told to ice it and take ibuprofen. That I would be the best judge of how much I could handle. :? Then again, I'm sure many of his patients aren't stuck toting around a 20+ lb kid all the time, too. Or lifting a 45lber into the car, out, onto the changing table, etc.

Can't say much about the brace. Different docs, different theories....

I wore one post injury, but again, the leg was broken. Then I had one post surgery for, like, ever, but I had the ACL replaced with 1/3 of my patellar tendon. That was worse than the ACL graft.

 

[RISkier]

Certainly not an expert. They can't really see much regarding the ACL or MCL with an X-Ray. At one time I had a micro fracture in my knee that primary care physicians couldn't detect. The stability test would suggest that you didn't tear it, but sprains can take quite a while to heal. So it's mostl likely a matter of ice and rest. Standing in a somewhat hyperextended position puts strain on the knees. If you don't feel like you're getting better an MRI seems to be the way to go. It's pretty much the only sure way to see what's going on.

 

[severine]

Mmmmm... insurance sucks. We'll have to pay 30% and I imagine MRI is expensive.

Maybe a few more days? I had already decided that I was probably only going to put in a few hours at MRG during that upcoming trip, and skipping SB altogether. It's not looking good right now though...

 

[Dr Skimeister]

Radiographs are not able to detect injury to soft tissue structures, such as ligaments. There is often a "flare" in the joint space that is associated with an ACL injury that might show up on the xray, but I would hope an orthopedist would not solely depend on that sign to diagnose a tear. MRI is a much more useful diagnostic tool.

Another consideration has to be an injury to the meniscus, the "bumper" between the femur (thigh bone) and the tibia (shin bone). Meniscus tears are not uncommon with cruciate tears, but can also occur independently.

If the pain has persisted despite the advised rest, use caution skiing on it as it is possble to make what may be a minor injury more serious that then necessitates surgery.

 

[severine]

The more I've read about it, the more I wonder if I tore or injured my meniscus. Especially given the fact that it got better, then worse again. Every morning I'm waking up with pain now, and it's getting progressively worse instead of better. Should have called yesterday... now I'll have to wait until Monday. Possibly going to try the other ortho in town (specialty in sports med) as a sort of 2nd opinion.

In any case, looks like I'm out for the season. Even if it miraculously does feel better in a couple of weeks, I'm not going to risk it in spring conditions.

 

[o3jeff]

Personally i would try the second guy. It sounds like the first guy already misdiagnosed you already(doing an xray vs. the mri since it sounds like an xray does not shows ligament or muscle damage) and therefore has already wasted valuable heal time. But then again I really don't know enough about xrays and mri other than what I read in previous posts here. But it sounds like if they originally would of done the mri, you would be on your road to recovery.

 

[Dr Skimeister]

Many meniscus tears are what are referred to as "bucket handle"tears. In that case, the flap that the tear created sometimes raises from the surface of the cartilage and in doing so exposes the nerve endings. Pain results when those nerve endings are exposed.

 

[MR. evil]

Mmmmm... insurance sucks. We'll have to pay 30% and I imagine MRI is expensive. ...

Ya, they are pricey. I had an MRI on my left hand a couple of months ago (torn ligament) and the bill was about $1400. But my insurance covered it. I was told that MRI's of the hand are the hardest and longest ones to perform (it took an hour) and I would imagine they cost more. So it may not cost as much to MRI the knee.

 

[severine]

I just keep reading and reading and reading. Looks like a good ortho should be able to diagnose just about as well as an MRI would assist. But again, no medical training here... just going by what I can read and first-hand experiences of others.

That said, I woke up this morning with NO pain. Sharp contrast to the last 2 days when it hurt more than it ever did before. So as to maintain this no pain scenario, I have been vigilant about not carrying the baby on that side, icing periodically, and taking ibuprofen. And out of the whole day thus far, I have only had a very mild discomfort a couple of times that did not last long. Could it be a breakthrough?

Calling the ortho in the morning... busy day tomorrow but hopefully they can get me in at some point. If I don't need to be out the rest of the season, then I don't want to be. Especially with new boots and skis in the works... and MRG/SB next week.

 

[severine]

Many meniscus tears are what are referred to as "bucket handle"tears. In that case, the flap that the tear created sometimes raises from the surface of the cartilage and in doing so exposes the nerve endings. Pain results when those nerve endings are exposed.

I have read about that. Will definitely be asking about the meniscus tear scenario.

 

[Paul]

Personally i would try the second guy. It sounds like the first guy already misdiagnosed you already(doing an xray vs. the mri since it sounds like an xray does not shows ligament or muscle damage) and therefore has already wasted valuable heal time. But then again I really don't know enough about xrays and mri other than what I read in previous posts here. But it sounds like if they originally would of done the mri, you would be on your road to recovery.

MRIs are really expensive, and are only done after an x-ray. The x-ray won't show soft-tissue, but it does rule-out breaks etc... Like I said above, A good ortho cal tell a lot by moving it around. If he/she believes there to be ligament, meniscus etc.. damage, then an MRI would be done. Calling for an x-ray isn't a mis-diagnosis.

 

[severine]

Appointment for tomorrow for 2:50PM. Sticking with the same guy. Knee is still pain-free (well, essentially) but feels a little weak. Understandable since I haven't done much with it in over 3 weeks. I'll see what he has to say tomorrow...

 

[severine]

Just got back from the orthopedist and it was not good. The pain was starting to come back today and now post-appointment, it's pretty bad. He moved my leg around in various positions, pushing and pulling, pressed on the knee... and said he really thought it would have been healed by now. He doesn't think the ACL is affected, but said that it's possible I tore my meniscus. They're ordering an MRI for me. I'm waiting for the call from them on when I can go, but it's likely I won't hear back until tomorrow because our insurance is out of state and they have to get approval from the insurance first.

 

[wa-loaf]

Ok, so I've been in denial about this for a little while, but I hurt my left knee almost two weeks ago in a collision with a snowboarder. I toughed it out for a week and made an appointment last week (on a really painful day) to see the Ortho. I just got back. First thing they did was hand me a sheet to go down and get xrayed. Got the xrays and came back to the office, the doc (actually NP) looks them over and checks out my knee. Looks like I might have chipped a piece of cartilage from kneecap and I'm going to get an MRI tonight to rule out an ACL tear. She also took about 15ml of fluid from my knee. I have a follow up on Thursday for with the NP and the Ortho. I also got a knee brace and I'm still optimistic about skiing Friday and Saturday. The NP though that was possible especially with a brace.

 

[severine]

Wow, that sucks. Though I guess it's good if the NP feels you can still ski with the brace on.

I asked about a brace at my first appt and was told I didn't need one. Didn't get to talk much at this appointment because my kids were trying to escape. I appreciate that he didn't make it a long, drawn-out thing (though it didn't seem like he rushed, either). I guess I just have to wait and see what the MRI says. And hope for the best. The sucky thing about meniscus is that in most cases, it can't repair itself - requires arthroscopic surgery. I'm REALLY hoping that's not the problem.

 

[wa-loaf]

Considering my experience, I'm very surprised that they didn't send you in for the MRI sooner. Seemed like it was a routine step they do.